238:, MD FACP) recognized an association of skin necrosis with use of levamisole adulterated cocaine. The mnemonic LINES (Levamisole-Induced NEcrosis Syndrome) was coined to name the syndrome because the name was descriptive, reminds one of a “line” of cocaine, and is easily remembered. Thus it is self exemplifying.
165:
The patient subsequently developed a temperature of 37.5 °C, expressed rigors, and night sweats. He returned to the ED the next day and on further history admitted to 3 weeks of "snorting 6–8 lines of coke a day" and smoking marijuana every evening to "come down". He was hospitalized and treated
178:
empirically. The next day erythematous painful papules appeared on his trunk, arms, face, and ears. Blood cultures were negative. There was prominent necrosis of the cheek region, nose, and lips with complete sparing of the back. Skin biopsy revealed extensive small vessel thrombosis throughout the
81:
but was primarily used for the treatment of parasitic infections. It was withdrawn from the U.S. market in early 2000 because of adverse health events. However, it is still approved in the United States as an antihelminthic agent in veterinary medicine.
505:
Mouzakis, J.; Somboonwit, C.; Lakshmi, S.; Rumbak, M.; Sinnott, J.; Cherpelis, B.; Keshishian, J. (2011). "Levamisole induced necrosis of the skin and neutropenia following intranasal cocaine use: A newly recognized syndrome".
126:. Several cases of severe agranulocytosis associated with cocaine use have been reported since 2006. With the recently recognized dermal disease, the face and ears are commonly affected, especially the bilateral
539:
227:
255:
Fredericks, C.; Yon, J. R.; Alex, G.; Morton, M.; Messer, T.; Bokhari, F.; Poulakidas, S. (2017). "Levamisole-induced
Necrosis Syndrome: Presentation and Management".
156:
49:
for cocaine. Spontaneous bruising of the earlobes is considered characteristic of this condition, but lesions can present anywhere on the body.
179:
superficial and deep dermal plexuses with perivascular mononuclear inflammatory infiltrate and a few neutrophils surrounding the vessels.
94:
in the brain, acts as a bulking agent, and is a difficult adulterant to recognize. Potential risks of levamisole-laced cocaine include
195:
of 17.54 mg/mL and platelets were slightly decreased. The patient's urine drug screen was positive for cannabis but not cocaine.
210:
extending from midthigh to the foot which necessitated below knee amputation of the right extremity. The patient also required
180:
152:
130:
and cheeks. However, there have also been case reports of involvement of the abdomen, chest, lower buttocks and legs.
119:
549:
282:
Larocque, Alexandre; Hoffman, Robert S. (2012). "Levamisole in cocaine: Unexpected news from an old acquaintance".
90:
Levamisole has become a common additive to illicit cocaine. It is thought to intensify the "high" by releasing
187:
IgM was weakly positive at 16.3; C4 was decreased at 10 mg/dl; antinuclear antibodies were negative and
455:"Complications Associated with Use of Levamisole-Contaminated Cocaine: An Emerging Public Health Challenge"
412:
Morris, G. W.; Mason, B. C.; Harris
Sprunger, R.; Hake Harris, H.; White, L. A.; Patterson, D. A. (2012).
151:
and severe malaise. Incision and drainage of the nodes was performed and he was discharged home with
78:
391:
307:
203:
515:
484:
435:
383:
366:
Chang, A.; Osterloh, J.; Thomas, J. (2010). "Levamisole: A Dangerous New
Cocaine Adulterant".
348:
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17:
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107:
235:
99:
74:
66:
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was reactive. Coagulation studies were within normal limits. There was an elevated
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184:
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127:
103:
95:
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was started and wound care was initiated. Epidermal necrosis then evolved to
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519:
488:
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379:
167:
111:
91:
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38:
188:
118:. The skin necrosis associated with levamisole toxicity ranges from
115:
147:
who presented to an urgent care facility with bilateral axillary
143:
LINES was first described in a 54-year-old male with history of
453:
Lee, Kachiu C.; Ladizinski, Barry; Federman, Daniel G. (2012).
228:
University of South
Florida Morsani College of Medicine
325:
Caldwell, K. B.; Graham, O. Z.; Arnold, J. J. (2012).
257:
Wounds: A Compendium of
Clinical Research and Practice
327:"Agranulocytosis from Levamisole-Adulterated Cocaine"
418:
The
Journal of the American Board of Family Medicine
331:
The
Journal of the American Board of Family Medicine
77:. It experienced some usage for the treatment of
540:Skin conditions resulting from physical factors
414:"Levamisole-Adulterated Cocaine: A Case Series"
500:
498:
8:
407:
405:
478:
429:
342:
41:recognized in 2011, caused by the use of
368:Clinical Pharmacology & Therapeutics
247:
27:Complication of adulterated cocaine use
218:to his face and left lower extremity.
86:Levamisole toxicity in cocaine supply
7:
31:Levamisole induced necrosis syndrome
37:) is a complication of adulterated
226:In 2011 a team of physicians from
25:
183:was elevated at 35 mm/hour;
69:, was previously approved as an
234:(under the attending service of
508:Journal of Drugs in Dermatology
181:Erythrocyte sedimentation rate
1:
214:to his chest and abdomen and
153:sulfamethoxazole/trimethoprim
18:Levamisole-induced vasculitis
471:10.1016/j.mayocp.2012.03.010
431:10.3122/jabfm.2012.04.110287
344:10.3122/jabfm.2012.04.110177
296:10.3109/15563650.2012.665455
120:leukocytoclastic vasculitis
566:
459:Mayo Clinic Proceedings
157:methicillin-resistant
380:10.1038/clpt.2010.156
159:Staphylococcus aureus
79:rheumatoid arthritis
284:Clinical Toxicology
139:Initial case report
204:Methylprednisolone
162:(MRSA) infection.
65:, a derivative of
550:Medical mnemonics
16:(Redirected from
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524:
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108:retiform purpura
21:
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236:John T. Sinnott
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100:agranulocytosis
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75:immunomodulator
67:imidazothiazole
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55:
28:
23:
22:
15:
12:
11:
5:
563:
561:
553:
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542:
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531:
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514:(10): 1204–7.
494:
465:(6): 581–586.
445:
424:(4): 531–535.
401:
374:(3): 408–411.
358:
337:(4): 528–530.
317:
290:(4): 231–241.
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145:hypothyroidism
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137:
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71:antihelminthic
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155:for presumed
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122:to occlusive
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47:cutting agent
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263:(3): 71–76.
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202:
164:
158:
142:
124:vasculopathy
89:
61:
34:
30:
29:
208:myonecrosis
185:cardiolipin
176:fluconazole
172:doxycycline
104:arthralgias
96:neutropenia
53:Description
534:Categories
242:References
216:autografts
212:allografts
149:adenopathy
63:Levamisole
58:Levamisole
43:levamisole
232:Tampa, FL
199:Treatment
134:Diagnosis
520:21968674
489:22677078
440:22773722
396:31414939
388:20668440
353:22773721
312:22421822
304:22455354
269:28355139
168:cefepime
112:necrosis
92:dopamine
545:Cocaine
480:3498128
222:History
193:d-dimer
128:helices
110:, skin
39:cocaine
518:
487:
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386:
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302:
267:
189:p-ANCA
174:, and
114:, and
392:S2CID
308:S2CID
166:with
116:fever
45:as a
35:LINES
516:PMID
485:PMID
436:PMID
384:PMID
349:PMID
300:PMID
265:PMID
73:and
475:PMC
467:doi
426:doi
376:doi
339:doi
292:doi
230:in
536::
512:10
510:.
497:^
483:.
473:.
463:87
461:.
457:.
434:.
422:25
420:.
416:.
404:^
390:.
382:.
372:88
370:.
347:.
335:25
333:.
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288:50
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261:29
259:.
170:,
106:,
102:,
98:,
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33:(
20:)
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